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Sara - Interview 28

Age at interview: 55
Age at diagnosis: 43
Brief Outline: Sara has experienced episodes of depression from adolescence. The death of her father and sister from a degenerative disease has profoundly impacted her life, and she currently takes antidepressant medication and sees a psychiatrist.
Background: Sara is a part-time counsellor. She is single and does not have children. Ethnic background' Australian.

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Sara had a good childhood but the family experienced hardship after her father’s diagnosis with a degenerative neurological disease when Sara was five. Her father’s physical and mental degeneration and the emotional impact of living with this disease profoundly affected Sara, making her feel ‘frustrated, angry and powerless’. Her father passed away when she was 17. On reflection she realises she experienced ‘periods of serious depression’ during her adolescence but was unable to talk to anyone about this because this was a time when adolescent mental health was not widely discussed.
 
Sara studied nursing and moved overseas when she was 23. Her depression eased during this time. However, on return to Australia, her depression 'returned'. Sara describes struggling to complete simple tasks when she is feeling depressed. She feels worse in the morning and she finds physical and cognitive activity a real struggle. When she experiences depressive episodes she can also be ‘very tearful, overwhelmed and overwrought’.
 
Sara was diagnosed with depression in the late 1990s. She visited her GP who referred her to a psychiatrist. Sara worked with this psychiatrist for a number of years to explore a range of issues, particularly her father’s illness, her sister’s diagnosis with the same illness and her own genetic predisposition. She says that her psychiatrist showed great patience over a number of years to explore with her all the issues, psychological and physical, that were contributing to her depression.
 
Her father and sister’s disease has also profoundly affected Sara’s adult life. Her sister passed away from the illness recently. Her concerns about her own genetic predisposition have impacted on all major decisions in her life. Sara did not take antidepressant medication when first diagnosed with depression, but is now taking it, which she says does help to 'level out' her mood. In the last two years Sara has been diagnosed with cancer, but says that a physical illness is easier to deal with in many ways compared with depression.
 
Sara describes recovery from depression in terms of regaining her physical and cognitive function and says adequate sleep and exercise are integral to her recovery. She also relies on the feedback from close friends who can assist her in 'monitoring' her well-being, which can be difficult to do alone. She deals with her depression by not taking on too much at work, exercise and adjunctive therapies. Sara has also found it useful to discuss the experience of living with depression as well as being diagnosed with cancer with friends and colleagues.
 

As a counsellor herself Sara says that continuation of care for people with depression is incredibly important. She says that for herself and others recovery from depression is ‘incredibly difficult’ and requires an enormous effort. She says it is important to ‘maintain a sense of hope and to live in the present’. Sara is optimistic about her future and says a key part of her getting better has been to come to a sense of acceptance about living with depression as well as good continuity of care. 

 

Aware of the different debates and perspectives on depression, Sara advised taking a cautious...

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I went off and looked at it and read it and have spent quite a bit of time understanding the process a bit more and understanding the sub diagnosis that he makes and I know that they’re not very popular  and I know that there’s a marked split in the psychiatric community with that and I think that’s a real shame. Because the argument is that there is no evidence for it. Well, clinically there is.
 
But the second part of that is I think that we live in a world where, for many people, and particularly young people, we’ve created an expectation that we need to be happy all the time. And that, if we’re not happy all the time then, and everything isn’t going the way we want it to go, then, then we’re depressed and I don’t think that’s true, necessarily.
 
And I’ve been interested in some of the literature that’s coming out around that. That idea of it sort of being a social construct, that, you know. But I still think people do get terribly depressed [laughs]. And hopefully more of them get some more help these days than they used to in the past. So I think you’ve got to be, I feel like I - you really need to be careful with that stuff.
 
 

Sara was critical about the application of a specific talking therapy to people who were severely...

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Some of my - I get really cranky sometimes with, with people who work in health care who have, you know, particularly who work on a very strong CBT model that, you know, my experience of depression is that when you are ser - severely depressed, you can’t cognate. You can’t read, you can’t concentrate, you can’t think, you can’t carry on a conversation, you can do nothing, virtually, except the simplest of tasks.
 
So to ask somebody to change their thinking in that situation, I think is unhelpful. And often, when it’s applied in a very prescriptive way it just gives them one more thing that they then fail at. And that’s not the way it’s used in lots of situations with really experienced practitioners but sometimes it, it can be used like that, as a panacea for all things. I think depression is more complicated than that. But then again, having said that, some people respond beautifully to very structured CBT.
 
 

Sara discussed times when her depression prevented her from working. The flexibility of her...

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Sara discussed times when her depression prevented her from working. The flexibility of her...

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Oh, practically [laughs] in terms of, you know, I mean, I’ve had episodes of very severe depression where I couldn’t, I couldn't work. I couldn’t, couldn't function, I couldn’t live independently.
 
Select people know. It’s not something that I, and I mean it’s interesting 'cause it’s not, you know, the people who need to know, know.
 
I mean I, the people that I work, some of the people I work with I had a very long, well one person who works there, I’ve had a very long relationship with. They know how sick I’ve been. So it was quite important for them to know. 'Cause I think one of the other things that’s quite important if you’ve had an episode of any sort of psychological or even physical illness, you - it’s really good to have somebody who knows when you’re going off, [laughs], who, who can help you monitor that, you know, how you’re going at any point.
 
So that’s been useful but yeah, no. you know, I had periods where I couldn’t work and didn’t work. 
 
Did you have many of those periods over the years?
 
Probably had about, probably had a period of about five years when things were on and off, more off than on. So the sort of work, I had -I compromised on my own, there was only certain sort of work I could do. I had to do work that was very simple and, and really not very intellectually or academically demanding and I just needed a job. So you know, I did very basic stuff for a while there.
 
I changed jobs and careers with, within my current workplace but no, in, in other workplaces, no. I just did what I needed to do. But it makes, I mean, it profoundly effects your financial you know, and your professional yeah.
 
 

Sara believed in the importance of a holistic approach to depression care, but warned against...

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Sara believed in the importance of a holistic approach to depression care, but warned against...

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Did you ever try, did you try any of that?
 
Oh yeah, yeah, yeah. I think the stuff’s really - well it depends. You know, there’s lots of stuff I think is really, potentially allows people to be quite exploited. You know I, I know of people who, who, who have gone to therapies that are neither structured or, or properly, check, there’s no checks and balances in it. They’re promised cure when there is no cure. I, I think, I think people, when they’re sick and they’re vulnerable are, are very at risk of being exposed, or very at risk of being taken advantage of. But having said that, I think there are a lot of, lot of a lot of alt - complimentary medicines that, that help. I think some of the nutritional stuff really helps well. I think that things like massage and bodywork really helps.
 
I think that should be part of that mainstream of treatment of depression and I think depression needs to be treated really holistically.
 
 

Sara talked about her depression and about her experience of working with young people with...

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Sara talked about her depression and about her experience of working with young people with...

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Oh I think there’s an enormous amount of stigma. I work with predominantly young people. There is a huge amount of stigma with having any sort of depression or any sort of mental illness or any sort of psychological stress still, for all the talking, for all the understanding, all the things we have, you know, it’s still, I think, in lots of people’s backgrounds, that sense of some sort of personal failing, that they should be able to get over in terms of managing their, their illness.
 
Interestingly, I think with a lot of young people it’s also, they also have that approach to their physical health. So if you get diagnosed with a juvenile diabetes, often it’s not dissimilar. But it’s even more complicated with mental health. 
 
I think there’s a real stigma in health care professionals about mental health. And that might just be, and that’s not something I’ve experienced but it is still a concern that I have. And I would be far quicker to tell people about my, about cancer than I would about the depression. Because I don’t know that there is - and that’s even amongst people who are health care professionals. [Laughs] You know, I think there is still attitudes associated with mental health that, that aren’t necessarily that helpful.
 
I think complex depression and treatment-resistant depression is a nightmare to treat. It’s a nightmare to try and live with. It’s a nightmare to sustain your level of hope if you have somebody, you know, a friend or a colleague who has it, that things will be different and things will change. I think it’s so difficult. 
 
It asks enormous amounts of us as human beings and a capacity of, of understanding and empathy that I don’t think most of us have most of the time. It takes too long and we now live in a world where we need quick fixes and we need it done neatly and quickly and all the rest of it. And it’s quite fascinating 'cause we don’t get that in physical disease either. But somehow we feel a bit more tolerant of that.
 
Perhaps we can see it. I think there’s still that perception underpinning a lot of this stuff, that if people really, with depression, if they really wanted to get better they could. For all the education, you know, perhaps it needs more, more statements like that from people who’ve had depression. 
 
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